Provider Demographics
NPI:1528342045
Name:JONATHAN B PURDY DPM APMC
Entity type:Organization
Organization Name:JONATHAN B PURDY DPM APMC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:PURDY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:337-256-8494
Mailing Address - Street 1:200 S LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-3916
Mailing Address - Country:US
Mailing Address - Phone:337-256-8494
Mailing Address - Fax:855-896-3338
Practice Address - Street 1:200 S LEWIS ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-3916
Practice Address - Country:US
Practice Address - Phone:337-256-8494
Practice Address - Fax:855-896-3338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-03
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADPM.PD323R213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DV32OtherMEDICARE PTAN
LA6608340001Medicare NSC